Dr Clare Materia Medica

 Also known as: African Ginger, Black Ginger, Gan Jiang.

Scientific name: Zingiber officinale.

Botanical Family: Zingiberaceae.

Part used: The parts of ginger used medicinally are the rhizome (root-like stem) and root.

Traditional use.

Ginger is used for: motion sickness, morning sickness, colic, dyspepsia, flatulence, chemotherapy-induced nausea, rheumatoid arthritis, osteoarthritis, loss of appetite, nausea and vomiting following surgery, and migraine headaches. It is also used for upper respiratory tract infections, coughs, bronchitis, for the promotion of sweating, as a circulatory stimulant and for treating stomach-ache, diarrhea and nausea for any reason.

Ginger is commonly used as a flavoring agent in foods and beverages.

Safety.

There are no concerns regarding safety when used appropriately. Ginger has been safely used in several clinical trials.^{(1,2,3,4,5,6,7,8,9,10,11,12,13)}

Pregnancy: There are no concerns regarding safety. Studies in pregnant women suggest that ginger can be used safely and effectively for morning sickness without harm to the fetus. As with any medication given during pregnancy, the potential benefit to risk must be weighed. See dose guidelines for use in pregnancy.

Breastfeeding: There are no problems with food levels of ginger in the diet. No scientific studies have been undertaken on therapeutic doses. All herbs and spices cross into breastmilk so only use therapeutic doses of ginger if there is a clinical indication that warrants therapy, weighing up relative risks and benefits of using the herb.

Constituents

Volatile oil; predominantly hydrocarbons including zingiberene, ar-curcumene and bisabolene.

Pungent principles; a mixture of phenolic compounds with carbon side chains. These are referred to as gingerols, gingerdiols, gingerdiones, dihydrogingerdiones and shaogaols. The shaogoals are formed during the drying process and are twice as pungent as the gingerols. Hence the dried ginger is more pungent than the fresh herb.

Constituents.

Oleoresin; including gingerol homologues including derivatives with a methyl sidechain.

Gingerglycolipids

6-gingesulphonic acid.

Starch, proteins (amino acids including arginine) and fat.

Vitamins; including niacin, and vitamin A.

Minerals.

Scientific evidence.

Morning sickness. Taking ginger orally seems to reduce the severity of nausea and vomiting with morning sickness. Ginger seems to be more effective than placebo and comparable to vitamin B6. ^{(1,4,10,14,15,16)}

Vertigo. Taking 1 gram of ginger orally seems to reduce symptoms of vertigo, including nausea.⁽⁹⁾

Osteoarthritis. Severalstudies have shown evidence of symptom relief as effective as ibuprofen and diclofenac (NSAIDs). One study showed benefit after twelve weeks of treatment. ^{(5,6,7,23,24,25)}

Muscle Soreness. One study showed reduction in muscle soreness in women. ⁽²⁶⁾

Painful periods. Two recent clinical trials in women demonstrated that  ginger for 3 days from the start of their menstrual period was as effective as mefenamic acid (Ponstan) and ibuprofen (Nurafen) and placebo in relieving period pain. ^(27,28)

Migraine headache. Anecdotal evidence suggests that ginger might reduce the severity and duration of migraine headache.⁽⁹⁾

Mechanism of action.

Active constituents of ginger include gingerol, gingerdione, shogaol, and sesquiterpene and monoterpene volatile oils.^(17,18) The chemical constituents of ginger vary among fresh, semi-dry, and dry forms of ginger.⁽¹⁷⁾ Ginger has a variety of pharmacological properties including; lowering fever, analgesia, cough inhibition, anti-inflammatory, sedative, antibiotic, weak antifungal, and other properties.^(19,17)

The mechanism by which ginger reduces nausea and vomiting might be due to the 6-gingerol constituent.⁽²⁰⁾ Other ginger constituents such as 6-shogaol and galanolactone seem to act on serotonin (a chemical transmitter in the nervous system, especially in the brain and gut) receptors.⁽²⁰⁾ Galanolactone seems to act primarily on serotonin receptors in the small intestine. Ginger has been shown to possess free radical scavenging, antioxidant, inhibition of lipid peroxidation and that these properties might have contributed to the observed gastro-protective effects.

Ginger is sometimes used for inflammatory conditions such as osteoarthritis and rheumatoid arthritis. Some researchers speculate that certain constituents of ginger might inhibit pro-inflammatory enzymes.⁽²¹⁾ Compounds found in ginger are capable of inhibiting PGE-2 production and that the compounds may act at several sites.⁽²⁹⁾

Adverse reactions.

Ginger is usually well tolerated when used in usual doses.

Interactions with herbs and supplements.

None reported.

Interactions with drugs.

None reported.

Interaction with warfarin is generally cautioned. However a study showed that in healthy subjects there was no alteration in the metabolism of warfarin.^(30,31) Undertake weekly monitoring for one month as an additional precaution.

Interactions with foods.

None known.

Interactions with laboratory tests.

None known.

Dosage.

Recommended dose: 1.5-6mls per day 1:5 tincture 70% alcohol.

Or for a stronger 1:2 tincture 90% alcohol the dose is from 0.25-0.5ml per day.

Decoction: range from tsps. per day.

Powder/capsule: range from 0.75-3gms per day.

Osteoarthritis

Oral: For morning sickness, 250 mg ginger 4 times daily, or 500 mg twice daily, has been used. ^(1,4,12,18) A higher dose of 650 mg 3 times daily has also been used.⁽¹⁶⁾ It may take 3-4 days of regular use to be effective. For motion sickness, 1 gram of dried powdered ginger root 30 minutes to 4 hours before travel has been used.^(8,22)

References.

1.  Fischer-Rasmussen W, Kjaer SK, Dahl C, Asping U. Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 1991;38:19-24.

2.  Phillips S, Ruggier R, Hutchinson SE. Zingiber officinale (ginger)-an antiemetic for day case surgery. Anaesthesia 1993;48:715-7.

3.  Bone ME, Wilkinson DJ, Young JR, et al. Ginger root-a new antiemetic. The effect of ginger root on postoperative nausea and vomiting after major gynaecological surgery. Anaesthesia 1990;45:669-71.

4.  Vutyavanich T, Kraisarin T, Ruangsri R. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstet Gynecol 2001;97:577-82.

5.  Bliddal H, Rosetzsky A, Schlichting P, et al. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage 2000;8:9-12.

6.  Altman RD, Marcussen KC. Effects of ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum 2001;44:2531-38.

7.  Marcus DM, Suarez-Almazor ME. Is there a role for ginger in the treatment of osteoarthritis? Arthritis Rheum 2001;44:2461-2.

8.  Grontved A, Brask T, Kambskard J, Hentzer E. Ginger root against seasickness: a controlled trial on the open sea. Acta Otolaryngol 1998;105:45-9.

9.  Grontved A, Hentzer E. Vertigo-reducing effect of ginger root. A controlled clinical study. ORL J Otorhinolaryngol Relat Spec 1986;48:282-6.

10.  Portnoi G, Chng LA, Karimi-Tabesh L, et al. Prospective comparative study of the safety and effectiveness of ginger for the treatment of nausea and vomiting in pregnancy. Am J Obstet Gynecol 2003;189:19-7.

11.  Wigler I, Grotto I, Caspi D, Yaron M. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 2003;11:783-9.

12.  Smith C, Crowther C, Wilson K et al. A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol 2004;103:639-45.

13.  Manusirivithaya S, Sripramote M, Tangjitgamol S, et al. Antiemetic effect of ginger in gynecologic oncology patients receiving cisplatin. Int J Gynecol Cancer 2004;14:1063-9.

14.  Jewell D, Young G. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev 2000;(2):CD000145.

15.  Borrelli F, Capasso R, Aviello G, et al. Effectiveness and safety of ginger in the treatment of pregnancy-induced nausea and vomiting. Obstet Gynecol 2005;105:849-56.

16.  Chittumma P, Kaewkiattikun K, Wiriyasiriwach B. Comparison of the effectiveness of ginger and vitamin B6 for treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thai 2007;90:15-20.

17.  Suekawa M, Ishige A, Yuasa K, et al. Pharmacological studies on ginger. I. Pharmacological actions of pungent constitutents, (6)-gingerol and (6)-shogaol. J Pharmacobiodyn 1984;7:836-48.

18.  Pongrojpaw D, Somprasit C, Chanthasenanont A. A randomized comparison of ginger and dimenhydrinate in the treatment of nausea and vomiting in pregnancy. J Med Assoc Thai 2007;90:1703-9.

19.  Langner E, Greifenberg S, Gruenwald J. Ginger: history and use. Adv Ther 1998;15:25-44.

20.  Lumb AB. Mechanism of antiemetic effect of ginger. Anaesthesia 1993;48:1118.

21.  Thomson M, Al-Qattan KK, Al-Sawan SM, et al. The use of ginger (Zingiber officinale Rosc.) as a potential anti-inflammatory and antithrombotic agent. Prostaglandins Leukot Essent Fatty Acids 2002;67:475-8.

22.  Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth 2000;84:367-71.

23. Wigler I, Grotto I, Caspi D, Yaron M. The effects of Zintona EC (a ginger extract) on symptomatic gonarthritis. Osteoarthritis Cartilage 2003;11:783-9

24. Haghighi M, Khalva A, Toliat T, Jallaei S. Comparing the effects of ginger (Zingiber officinale) extract and ibuprofen on patients with osteoarthritis. Arch Iran Med 2005;8:267-71.

25. Drozdov VN, Kim VA, Tkachenko EV, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Alt Compl Med 2012;18:583-8.

26. Int J Prev Med. 2013 Apr;4(Suppl 1):S11-5.

Influence of ginger and cinnamon intake on inflammation and muscle soreness endued by exercise in Iranian female athletes.

Mashhadi NS1, Ghiasvand R, Askari G, Feizi A, Hariri M, Darvishi L, Barani A, Taghiyar M, Shiranian A, Hajishafiee M.

27. Giti Ozgoli, Marjan Goli, and Fariborz Moattar. The Journal of Alternative and Complementary Medicine. February 2009, 15(2): 129-132. doi:10.1089/acm.2008.0311.

Published in Volume: 15 Issue 2: February 23, 2009

28. Effect of Zingiber officinale R. rhizomes (ginger) on pain relief in primary dysmenorrhea: a placebo randomized trial

Parvin Rahnama, Ali Montazeri, Hassan Fallah Huseini, Saeed Kianbakht and Mohsen Naseri. BMC Complementary and Alternative Medicine 2012, 12:92 

29. Phytomedicine. 2007 Feb;14(2-3):123-8. Epub 2006 May 18.

The effect of extracts from ginger rhizome on inflammatory mediator production.

Lantz RC1, Chen GJ, Sarihan M, Sólyom AM, Jolad SD, Timmermann BN.

30. Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects

Xuemin Jiang¹, Kenneth M. Williams², Winston S. Liauw², Alaina J. Ammit¹, Basil D. Roufogalis¹, Colin C. Duke¹, Richard O. Day² andAndrew J. McLachlan. British Journal of Clinical Pharmacology

Volume 59, Issue 4, pages 425–432, April 2005

31. Badreldin H. Ali,Gerald Blunden, Musbah O. Tanira, Abderrahim Nemmar. Some phytochemical, pharmacological and toxicological properties of ginger (Zingiber officinale Roscoe): A review of recent research. Food and Chemical Toxicology

Vol. 46, Issue 2. February 2008, Pages 409–420